National Mental Health Care Conference 2010
LIVING LIFE TO THE FULL
LIVING LIFE TO THE FULL
Speaking Notes of
Most Rev. Diarmuid Martin
Archbishop of Dublin, Primate of Ireland
Conrad Hotel, 16th September 2010
I would like to join with Minister Moloney in congratulating the organizers of this Conference on the Future of Mental Health Care in Ireland. The Conference addresses issues of importance for many individuals, for their families and indeed for Irish society as a whole. It is timely that our reflections on the significance of mental health care takes place when health care overall has to address serious economic challenges and when it is vital to prioritize the requirements of mental health care as we reflect on how best to how to allocate scarce resources.
I speak as a religious leader. The basic biblical teaching about humankind is that God created human persons in his own image and likeness. In the biblical tradition that basic affirmation is amplified to read “male and female he created them”. Taken together these affirmations stress two values: we are created with innate dignity in God’s image and likeness and we are created as relational beings. Mental health care is about respecting and enhancing human dignity and best enabling people to enter into mature and healthy relationships.
What do we mean by the image and likeness of God? Firstly let us look at the concept of God. If we misunderstand who God is, then we misunderstand who we are. In the Christian tradition God is not a distant God or a simply a remote first cause. For the Christian tradition, God is love. If God is love and we are created in God’s image then we are saying that human beings are created to be loving people, people able to love and to be loved. If we mistake God as some distant punitive being, then our own self-understanding will be distorted and our ability to love ourselves and others will be warped and our self-esteem will be undermined.
The Christian understanding of God as Trinity means that God is not a closed God. God’s own life is about communicating and above all about loving. Once again we see that if God’s own life is about love and intercommunication, then being fully human is not about individualism, but about being able to communicate and to love.
There is no need to be anxious; it is not my intention to give a homily or a theological lecture this morning. I wish however to base my reflections on the future of mental health care from my point of view as a religious leader. It is also important to openly face areas where false understandings of religion can lead to particular mental health problems.
When I was in primary school my religious education was essentially based on a very abstract catechism. I still remember some of the questions and answers and they were drummed into my memory so effectively that I have a feeling that, even in the days of inevitable memory-loss as the years pass, those catechism answers will probably be among the last things to vanish from my memory!
When I moved to secondary school we moved to another form of religious education. We learned about the miracles of Jesus, but we learned about them in a strange and unusual context: to prove that Jesus was God. The argument was simple. Jesus worked miraculous acts, he healed the sick, he raised people from the dead, he calmed the seas. Jesus therefore had special powers which went beyond any human explanation, therefore he was God. It was a perfectly rounded argument which, the theory went, even the most ardent atheistic communist would be unreasonable to reject.
I am not sure how many communists were actually moved by such reasoning or indeed how many of us students ever went out to convert the communists. That is not the point I wish to make. What was totally absent from this reasoning was the nature of the miracles of Jesus. Jesus did not work tele-miracles. He was no miracle showman. His miracles were primarily miracles of care, of care for people who for various reasons had not been able to live their life to the full. His miracles were miracles of healing and freeing people from the physical and mental barriers which had ensnared their lives. The miracles freed them so that they could live their life in a different way, re-establishing in themselves that fundamental dignity of bearing within them the image of God.
Jesus did not work tele-miracles. He encountered each sick or troubled person individually. He laid hands on them individually. Far from performing dramatic publicity-seeking gestures, Jesus constantly told those he cured not to tell anyone. Very rarely did he invite those whom he cured to join the company of his disciples and move to the next villages with him preaching the kingdom; rather he sent them back restored into their communities. The aim of healing was not to create a new group of the healed to be utilized, even for his own mission; their return to wholeness was a value in itself. It was sufficient that the person has regained the fullness of his or her dignity and could take up normal life again.
Mental health care has to set a similar aim, that of enabling every person to live as full a life as possible for as long as possible, being assisted where necessary but above all without creating any sense of long-term dependency. Mental health care is not just about resorting to drugs or institutionalisation however necessary they may be. Mental health care is about the wholeness of the person and mental health care must constantly seek new ways to address the effective recovery of wholeness, especially in the face of the distressing conditions such as that of depression.
That wholeness and restoration of dignity cannot be isolated from the dimension of relationship which is another dimension of being human. Mental health care is not just about treating a series of isolated individuals. Each individual exists within a network of relationships. The cause of mental illness may in many cases be rooted in relationships which were profoundly damaging, whether through dysfunctionality or through some form of abuse or exploitation. Restoration of wholeness requires addressing the relational origins of disease, as is done for example in family therapy. It may require an intense effort to enable people to have the confidence once again to establish relationships, particularly when confidence has been undermined by abuse or exploitation.
It is also interesting to see how those cured by Jesus are sent back to their communities, even though these communities may not be the ideal. Lepers are told to go back and show themselves to the priests, to the rituals of the times which would certainly not reflect the professional standards of today. The point is that those who are healed are sent back into the real world, to their community whatever it is like. Healing also entails an ability to cope and to live not just in an ideal world but in the real world with all its limitations and compromises.
I imagine that much of your discussion today will focus on the role of community in mental health care. There has been, thank God, a radical change from institutionalization of the mentally ill – still needed today in some circumstances and for the time necessary – to care within the community. But what type of community? The community to which mental health care is entrusted must be a caring community. And that is not always the case, especially in its attitudes towards the mentally ill. There is no way either in which a dysfunctional community will heal dysfunction.
A healthy community has to address a series of taboos and elements of stigma which have traditionally been attached to mental health and still exist today. It will be necessary to address the personal emotions and anxieties of those close to the person suffering from mental illness. They will find it hard to cope in the best of circumstances, but they will find it impossible to cope if certain misunderstandings of mental illness continue to remain in public opinion.
Some forms of mental health bring extraordinary pressures of families and other supportive relationships. Restoring wholeness in the case of alcoholism or compulsive gambling means, for example, bringing wholeness back into a family relationship and restoring that relationship into a supportive and fulfilling context.
I believe that there is a special role here for community organizations and religious organizations to be more active. Religious bodies need also, however, to carry out a proper exegesis regarding some biblical references which refer to mental illness as the fruit of sinfulness or even diabolical possession. The primary emphasis of the Gospel message is that of freeing people from their burdens, no matter how these burdens were interpreted in the culture of the time of Jesus, and of rejoicing in the restoration of wholeness and dignity.
The danger still persists that some religious figures can seriously aggravate suffering and scruples by spurious religious theories and rituals. It is sad to see that a religion which is based on love and liberation from burdens can be distorted by some of its exponents to bring darkness and burden on people and to entrap them in anxiety rather than freeing them for life. As an aside, I might say that in the Archdiocese of Dublin in the past 20 years there has not been a single case of alleged possession investigated by the diocesan authorities which could not be explained in psychological terms. A Christian minister should be a minister of a message of love, one who enables people to enter into loving relationship, rather than creating new fears.
The Church has a good record in providing quality centres for mental health care of the young and the old, both in institutions and in the community. I know that this will be taken up in this afternoon’s session. Community care requires ways of building a participative community where people share burdens and where the weak are supported and carried. A religious presence in community care is not a question of substituting medical science with religious theory, much less any form of proselytism or exploitation for advantage. But there is a sense in which one’s religious faith, if it is authentic, can enhance one’s own professionalism and the quality of the professional medical service we provide. Much depends on the personal integration of our values into the manner in which we act.
Sadly this was not always the case. Recent reports have amply documented how many of the poorest and most vulnerable in our society were provided with poor quality care, in institutions and services provided by religious bodies. I constantly repeat to anyone within the Church involved in health care and the provision of social services that the poor deserve only the best. No one will be grateful to you if you provide poor quality care, even if it can be shown that in part this is due to inadequate public resources being available. Poor quality care will always be damaging to people and good intentions will not change that situation.
Poor quality care means any care which does not engage with those cared for in a loving relationship. You can have great care in poor facilities. You can have nice facilities with poor human care.
Ireland is undergoing a very difficult economic crisis in which necessary reduction in public expenditure is inevitably going to bring about a reduction in services and in the quality of services in health care in general and in mental health care in particular. Some of this can be made good by greater voluntary community involvement. However, increased voluntary community commitment will not spring up on its own. It must be fostered and it must be focussed on where such commitment is most needed and is most effective. Increased voluntary community commitment requires an appropriate policy framework if it is to be effective.
I would be particularly concerned about any drastic reduction in the level of services which permit people suffering from mental illness to live within the community, with support where necessary or even in a sheltered environment. Cutbacks in this area could rapidly result in many people no longer being able to live a full life on their own or with their family. The only alternative in such a situation would be institutional care and the facilities for such care in many cases no longer exist and without funding and regulation could easily end up being exploitative of the vulnerability of the mentally ill. This is an especially worrying challenge for the elderly in general and even more so for the elderly suffering from mental illness.
Let me say something about the question of the sexual abuse of children. I never for a moment imagined, in my work as a pastor, that I would have had to address the sexual abuse of children on such a wide scale, and that within the Church of Jesus Christ in Dublin. I express my recognition to those individuals and organizations which have brought attention to this serious problem and to the immense suffering that victims have endured, through abuse and through the lack of recognition of what happened to them. Abuse was reinforced by covering it up.
The Church is putting into place its own structures to address past and present aspects of this crisis. There is no way forward for the Church in carrying out its mission without adequately addressing its past. Addressing the past is painful, but it can be cathartic and liberating. Assessing the truth of the past objectively and accurately is a precondition for assessing what is happening today. A cultural framework which does not recognise and learn the lessons of its past will never constitute a suitable framework for moving towards a different future.
The Church has to address its past – honestly and completely – but it cannot be imprisoned in its past. Healing, however, takes time and must go forward at it own pace. There is no such thing as fast-track healing for victims. The aim of healing is to restore victims to full realisation of a self esteem of which they have been robbed. Regaining full confidence in relationships and self esteem is a slow process which can encounter many set backs, above all when victims perceive that there is an unwillingness to recognise the past or simply to put it aside as if it were no longer relevant today.
The problem of child sexual abuse is of course greater than the Church. I would hope that a wide coalition of groups might foster the use the tenth anniversary of the SAVI Report to take up the broad question of the sexual abuse of children in our society and to update and correct map of where this is taking place and whether our response to it is focussed and sufficient. I am particularly concerned about the slowness in addressing weaknesses in our current legislation, in addressing inadequacies in the resources available to the HSE, but also in addressing lack of clarity in the mandate of the HSE regarding the abuse of children outside a family framework.
Survivors need support in bearing wounds that may well remain with them perhaps for the rest of their lives. Families of those abused need support. One of the needs that many survivors have spoken to me about is also that of spiritual support and of being able to regain a sense of spirituality, especially where abuse took place in the context of betrayal of a spiritual mandate.
The question of perpetrators also needs examination. There is no adequate monitoring of perpetrators who are living in society. Many may constitute serious on-going risk to children. It is not a question of witch-hunting which is never in the interests of child protection and safeguarding. Prison without such therapy will only perpetuate the problem and the risk.
What are needed are programmes of rehabilitation and therapy in order to enable those who have offended to be in charge of their lives, to recognise the signs of regression. We must provide programmes which provide support to perpetrators and which at the same time protect children. The Archdiocese of Dublin has employed for some years a person who specifically provides support and monitoring of priests who have offended. It is one small step.
I also believe that here is need for some way of helping and care for people who discover that they may have a paedophile tendency, but have neither committed nor would wish to commit any criminal activity. It must be one of the most horrible and fearful secrets that a person has to bear in their hearts. I believe that some form of confidential care could be provided to enable such persons to cope with their situation well before they reach a crisis point. Preventive care must be an essential dimension of mental health care in all areas.
There is no way in which I would have the competence to set out the various areas where prevention is needed. Certainly we can all agree that we need urgently to address the question of suicide prevention and especially that of youth suicide. The current economic crisis will unfortunately inevitably lead to an increase in suicide.
I set out in my reflections looking at some of the basic religious tenets which I believe are relevant to reflection on mental health care in the future. My aim was not to present a narrow religious framework or platform but to look at some basic values about life and love and the value of life which spring from religious inspiration but which we can all share.
Mental health care is about people, and not just about techniques. It is about people who have become fragile and distressed, but who share the same dignity as all of us do. Our processes of healing and caring should be those which aim to ensure that others can enjoy life to the full and that we rejoice in the fact that our work as individuals and as a community can help restore dignity and the ability to establish healthy relationships to those who have not been able to enjoy wholeness. There are few callings which can be so noble and as fulfilling as one which restores others to personal fulfilment. I hope that in the years to come we can be more and more successful in this challenging task.